Professor Alan Maynard decodes the White Paper’s literary and political influences

The primary characteristics of the recent White Paper on the NHS, Equity and Excellence: Liberating the NHS are incoherence and ambiguity. The consultation papers that have emerged subsequently do all too little to reduce the conclusion that Chairman Lansley is not sure where he is going.

’Incoherence and confusion are both an opportunity and a threat.’

Professor Alan Maynard assesses the impact of the "blank" White Paper and associated restructrings and power shifts

The White Paper published earlier this month was in effect a “blank paper”, lacking detail of both the Government’s objectives and how reform was to be achieved.

Since then, Sir Humphrey and his fellow civil servants have striven mightily not just to put flesh on the bones, but also to reveal vital parts of the skeleton which were omitted from the “blank paper”.

Professor Alan Maynard looks at what a future based around outcome measurement and new incentives will mean.

The Coalition’s reforms depend for their success on the creation of an efficient set of incentives which “bring the horses to water and makes them drink” in a co-ordinated and efficient way.

As the dust settles from the White Paper where are we? Apart from the mere issues of detail to be provided in the ten (yes, ten!) consultations in the next few weeks - essential beach reading, with comments requested by October 5th - what is changing?

Goodbye old bureaucracy, hello new bureaucracy
There is a major assault on bureaucracy, with PCTs and SHAs to go. But hold on a minute: aren’t the proposed GP commissioners just PCTs run by GPs?

Moving from 152 PCTs to 500 GP commissioning consortia (GPCCs) is like going back in time to when we had 300 or so too many PCTs.

Professor Alan Maynard looks for the evidence justifying proposed new changes. And looks. And looks …

“Christianity has not been tried and found wanting; it has been found difficult and not tried” GK Chesterton

Chesterton’s views on Christianity are replicated in healthcare by policy wonks who base their works on faith rather than evidence. The left declare all things “private” to be the devil’s work, whilst the right regard government as twice cursed!

Professor Alan Maynard OBE looks at the emerging elements and wicked issues from the current policy fog

The English NHS is scheduled to have its most significant “redisorganisation” since the 1970s. As ever, it is well-intentioned but largely evidence-free.

Furthermore, the details of the changes are lacking - and HM Treasury is currently very worried about ensuring that GPs are accountable. The idea of GP accountability is a nice issue, as primary care has largely been a data-free black hole since 1911.

You say you want a revolution …

Professor Alan Maynard OBE minds the gap between political rhetoric about openness, choice and outcomes and the practical reality of lacking comparative data – and the implications for NHS redisorganisation.

The political rhetoric is of openness in all the workings of the NHS.

The practice is of avoiding confusing consumers with facts.

Both New Labour and the new Government must know that their advocacy of patient choice is empty cant unless consumers are informed about the risks involved in using healthcare facilities.

Professor Alan Maynard OBE notes the lack of evidence for the 30-day unpaid emergency acute readmission policy, and politicians’ and policymakers’ poor use of evidence more broadly.

Politicians in all parties advocate the use of evidence in making difficult policy decisions.

Professor Alan Maynard OBE reviews the validity of the idea that teaching hospitals have higher running costs

Traditionally, it has been argued that university teaching hospitals are more costly to operate. The primary argument to support this assertion is that they have a more complex case-mix.

Is this argument tenable, or is it a case of special interests defending their inefficiency?

Economics teaches us that larger units may have lower costs due to economies of scale and economies of scope. Why are these hospitals exceptions?

Professor Alan Maynard reviews the reasoning behind government proposals for spending another £200 million on new cancer drugs not recommended by NICE health technology appraisal

The Conservative manifesto pledged an additional £200 million to fund cancer drugs, which the previous government and NICE had been reluctant to fund.

Is this a good idea?

The answer to this simple question is it all depends on what you are trying to achieve.